Clinical Features and Outcomes of Glaucoma Surgery–Associated Bullous Keratopathy: A Subanalysis of the Japanese National Survey on Corneal Transplantation

PURPOSE: The purpose of this study was to investigate clinical characteristics and 1-year outcomes of glaucoma surgery-associated bullous keratopathy (BK), comparing eyes with prior incisional glaucoma surgery (IGS-BK) and laser iridotomy (LI-BK), using data from the Japanese National Survey on Corneal Transplantation. METHODS: Among 1941 BK eyes, 404 IGS-BK and 353 LI-BK eyes were analyzed. Clinical parameters and 1-year graft clarity were compared. Within IGS-BK, glaucoma subtypes were examined. Univariate (n = 382) and multivariable (n = 371, excluding cytomegalovirus and pediatric glaucoma) logistic regression identified predictors of graft failure. RESULTS: IGS-BK patients were younger (72.8 vs. 77.2 years, P <0.001) and predominantly male (64.6% vs. 18.4%). Primary open-angle/normal-tension glaucoma (34.7%) and exfoliation glaucoma (XFG) (30.0%) were most common. Descemet stripping automated endothelial keratoplasty was the predominant procedure (81.7% IGS-BK; 78.2% LI-BK). One-year graft clarity was lower in IGS-BK (82.2% vs. 90.5%, P = 0.002), with XFG showing the poorest outcomes (73.0%). Univariate analysis identified male sex [odds ratio (OR) = 1.83, P = 0.046], younger age (OR = 0.75 per 10-year increase, P = 0.008), and XFG (OR = 2.63, P = 0.004) as predictors of graft failure. After multivariable adjustment, XFG remained an independent risk factor (OR = 3.00, 95% confidence interval: 1.50-5.99, P = 0.002), as did younger age (OR = 0.72, P = 0.019). Complication profiles differed between groups. CONCLUSIONS: XFG independently predicts poor outcomes in IGS-BK, underscoring the importance of glaucoma subtype stratification. Patients with XFG require intensified perioperative management and postoperative monitoring to optimize graft survival.